Operative treatment of displaced mid-shaft fractures of the clavicle reduces complications .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(12):58 J Bone Joint Surg Am. 2012 Apr 18;94(8):675-84This meta-analysis identified 6 randomized clinical trials that compared operative and non-operative treatment of acute, displaced mid-shaft clavicle fractures. Results from this analysis indicate that there was a reduced complication rate in the operatively treated patients, with a decrease in non-unions and symptomatic malunions. A greater number of patients treated operatively were able to return to moderate activity 16 days following the injury, demonstrating that operative treatment provides superior early outcomes.
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Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
The non-union rate of acute, displaced mid shaft fractures treated non-operatively has been reported to be as high as 15-20% and has detrimental effects on shoulder muscle strength. Based on these suboptimal outcomes for non-operative management, primary operative care has increased in popularity. The meta-analysis was conducted to evaluate treatment effects, potential harm and patient outcomes of these differing methods.
¿Cuál era la pregunta principal de la investigación?
Which treatment, operative or nonoperative, provides the best clinical and functional results, and what are the complications associated with these procedures for patients presenting with displaced mid-shaft fracture of the clavicle?
- Non-union rate was significantly higher in the non-operative patients (29/200), than in the patients treated operatively (3/212) (p=0.001)
- The rate of patients with a symptomatic malunion was signficantly greater in the non-operative group (17/200), compared to the operative group (0/200) (p<0.001)
- The overall complication rate was significantly greater in the non-operative group (84/200), compared to the operative group (62/212) (p=0.0075)
- Three studies reported Constant Shoulder scores at one year weighted operative average was 94.3 compared to the non-operative average of 90.2
- DASH scores appeared to favor the operative group, but only reported numerically in 2 studies and graphically in one
- Early return to moderate activity on the 16th day was possible in 80% of the operatively treated patients, compared to 55% in the non-operative patients
¿Qué es lo que más debo recordar?
The results from this meta-analysis indicate that operative treatment of acute, displaced mid-shaft fractures of the clavicle provides a reduced rate of complication with fewer patients suffering non-union or symptomatic malunions. A greater number of operatively treated patients also were able to return to function earlier than the conservative treatment.
¿Cómo afectará esto al cuidado de mis pacientes?
The results from this meta-analysis support the use of primary operative treatment of acute, displaced mid shaft fractures of the clavicle.
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